Navigating challenges while implementing strategy

Healthcare leaders today are facing pressure from many angles to develop and deploy strategies that are successful in achieving critical objectives. These include goals for patient care, experience and safety, infection control, provider sustainability, staff efficiency and financial results.

With market and industry challenges mounting, there is less room for error than ever before. Data-driven metrics coupled with an understanding of the more nuanced aspects of planning are essential to achieving the goals outlined in a complex strategy. Leveraging data to ensure active and productive participation, flexibility and adaptation where necessary, and a solid understanding of core planning initiatives are keys to implementing strategic goals.

Using metrics wisely

In order to be most effective, metrics must be realistic. The stakes are often high during the implementation of new strategies, with promises riding on the outcomes. In a goal-oriented setting, the metrics around strategies tend to be aggressive, but if the team cannot achieve the metrics, it can defeat a strategy. Metrics that are realistic and attainable, particularly in the first year, are key to success. As the strategy takes hold and begins to gain traction within the market, the metrics can slowly be advanced.

In addition to setting realistic, attainable metrics, the total number should be manageable. It may be tempting to monitor and track scores of metrics, especially with popular tools such as “data dashboards.” However, teams can get lost in managing the data, focusing more on tracking the metrics than on executing the strategy. It is better to choose three to five core metrics representing the outcomes that demonstrate the effectiveness of the strategy.

Key considerations

An appropriate mixture of quantitative and subjective or “soft” metrics will provide the most accurate picture of the success level. For example, when expanding a practice and cultivating new physicians to join the group, interpersonal dynamics cannot be quantified but they can have a big impact on the success or failure of the venture. New physicians can increase volume, revenue, throughput and referrals—all quantitative measures of success—but the strategy can still be derailed if there is a conflict between new physicians and the leadership or culture of the new organization or a failure to achieve quality standards and compliance.

Acquisitions are another area with a softer side to the quantifiable data. For example, when a large hospital acquired a smaller, failing hospital in a nearby community, there was community resist the proposed strategy of eliminating inpatient beds at the smaller hospital and converting it into an ambulatory care center. From the perspective of pure quantitative data, there was no need—and it was too costly—to have two hospitals duplicating services in a market that was too small to support them. However, the rural community felt a connection to the hospital they knew, and they resisted the inconvenience of driving a few additional miles to the larger hospital. People felt their healthcare options were being limited, so the strategic campaign emphasized what they were gaining versus what they stood to lose.

The board had to make the community understand that the acquiring owner could provide ambulatory care at the smaller community hospital, which provided a major benefit they otherwise would not have had if the hospital had simply closed.

Look beyond symptoms for root causes

In healthcare, a focus on diagnosing and managing a patient’s symptoms can distract a provider from looking deeper for root causes, and this can occur in the strategic realm as well. In the case above, the root cause of the challenge was twofold: Patients don’t want to travel father to the hospital, and they want continued access to family physicians in their own community. The overarching strategy in this case was to reduce overhead cost, not to increase convenience and comfort for patients. Nevertheless, the board made that strategy more palatable to the community.

While keeping patients happy is paramount, keeping physicians happy may be just as important. The cause of most challenges in physician acquisition is work-life balance. Physicians want to spend more of their time seeing patients and less time on paperwork, HR and other practice management tasks. When physicians are absorbed into a larger system, these tasks are often delegated to other departments, leaving them with more time to see patients. Many physicians are willing to take a slightly lower salary if their needs and desires are prioritized. When healthcare strategists get caught in the trap of managing symptoms instead of solving the root problem, they can fail to see that meeting the needs of the end user is a strategic priority.

With the industry in constant flux, some leaders second-guess their strategies to avoid risk. Market uncertainty is a major consideration in healthcare, but the root cause of that uncertainty centers around reimbursement. Leaders are often indecisive about closures, physician acquisitions and opening new service lines because of the risk that their strategy may not be sustainable long term.

Assessing the risk profile of a strategy enables decision-makers to gauge its viability. In the example of converting a small, failing hospital to an ambulatory care center, the hospital and the patients are competing interests. The patient desires access and convenience; the hospital’s drivers are revenue and savings. Public relations at the community level and revenue at the main hospital are both at risk. In a rural setting, the risk is much lower than it might be in an urban area, where referral shifts with the providers, and patients have more options. In a low-risk scenario, the key to balancing the risks is to manage the message and make sure everyone feels their needs are being considered.

Solving strategic challenges

When there are issues in deploying a strategy, risk assessment comes into play and the strategy is amended to deal with the roadblock. Implementing a workaround inevitably causes a delay, which can pose additional risks if the strategy is time-sensitive. The ideal solution is to remove the roadblock, depending on whether the risk of removal is higher or lower than the risk posed by the delay.

For example, in one acquisition scenario, the new owner offered to replace an outdated facility offering a certain capital investment over time as the market demand warranted it. However, the lack of patient demand was root cause of the hospital’s failure. The new owner was unspecific about when, how and where the replacement would be built and, because the demand did not justify the return on investment, the project was put on hold. The new owner presented a roadblock to the hospital that had been acquired. The hospital chose to remove the roadblock by activating a clause in the agreement that allowed them to bow out of the deal if they disagreed with the handling of the acquisition.

Workarounds are more common in hospital operations. For instance, if the strategy is to reduce wait times and increase access and convenience, but a particular physician is not following standard care practices protocols, a workaround could require other staff to compensate to achieve core metrics. Such layered workarounds typically have so many ramifications that it becomes difficult to move forward. Clarity is critical in the strategic initiative and its deployment. If practitioners know which performance metrics are being used to hold them accountable, they will be more likely to avoid workarounds that stymie progress. In those unique cases where a workaround seems necessary, it is essential to decide whether the workaround strategy is the only option, or if it can be removed or negotiated.

The Human dimension of strategic success

The most successful deployments are those in which people are informed and educated about the strategy and the metrics on which progress is measured. Often, when participants are resistant, it’s because they don’t understand their contribution. They must be informed about the impact of their behaviors and decisions on the achievement of strategic goals. This understanding can lead to operational/clinical standardization practices that reduce waste and focus on quality of care and patient outcomes. There is a plethora of data that show the collective savings and positive outcomes resulting from standardization. When people understand the data and their role in achieving strategic goals, they are more likely to be enthusiastic about participation, resulting in better outcomes. In turn, they are more likely to share their experience with peers, which accelerates the adoption curve for the new strategy.

It takes a particular personality type to excel at strategic implementation. Most people see things as black and white, but the multi-dimensional thinkers who are able to see the gray area and explain it to others are best at this task. While identifying and developing strategy is key, deploying strategic initiatives is a journey in its own right. Each step along the way reinforces progress toward the strategic goal.

Michelle Mader is the president of Catalyst, FreemanWhite, a healthcare design and consulting firm. Contact her at mmader@freemanwhite.com.